强直性脊柱炎患者细胞毒性T淋巴细胞变化

目的 探讨细胞毒性T淋巴细胞(T-lymphocytes,Tc)在强直性脊柱炎(ankylosing spondylitis,AS)患者中的表达变化.方法 筛选42例AS患者作为研究对象(病例组),20例同时期健康查体者作为对照(对照组).检测2组血小板计数、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-neactveprotein,CRP)水平并记录强直性脊柱炎病情活动指数调查表(bath ankylosing spondylitis disease activity index,BASDAI)评分.应用流式细胞仪检测外周血中淋巴细胞表型(CD3+CD8+)、胞浆内细胞因子γ干扰素、白细胞介素4的表达.采用t检验分析两组间外周血中Tc、Tc1、Tc2、Tc1/Tc2比值的差异;相关分析采用Pearson检验.结果 病例组与对照组外周血中Tc分别为(21.22±4.27)％ vs (14.23±4.15)％ (t=6.177,P＜0.01),Tc1分别为(0.35±0.08)％vs(1.45±0.27)％(t=24.640,P＜0.01),Tc2分别为(0.53±0.12)％vs(0.41±0.12)％(t=3.608,P＜0.01),Tc1/Tc2比值分别为0.72±0.29vs3.93±1.63(t=6.431,P＜0.01).相关分析显示AS患者外周血中Tc、Tc1、Tc2、Tc1/Tc2比值与血小板计数、ESR、CRP、BASDAI均无相关性.结论 AS患者外周血中Tc1细胞减少,Tc2细胞增多,的确存在Tc1/Tc2细胞的失衡,而且是Tc2细胞占优势.     

内热针治疗中晚期强直性脊柱炎的疗效观察

目的观察内热针治疗中晚期强直性脊柱炎的临床疗效和安全性,探讨其应用前景。方法62例中晚期强直性脊柱炎患者按就诊顺序分为采用内热针治疗的治疗组(31例)和采用常规针刺治疗的对照组(31例),连续治疗8周后观察2组患者治疗前后的主要症状及体征(胸廓活动度、枕墙距、指地距、Schober试验),实验室指标(血沉、C反应蛋白),脊椎疼痛VAS评分、Bath强直性脊柱炎功能指数(BASFI)和Bath强直性脊柱炎疾病活动指数(BASDAI)。结果2组患者治疗后的主要体征、脊柱疼痛VAS评分与治疗前比较均有明显改善(P<0.05);2组之间在枕墙距、指地距、Schober试验、脊柱疼痛VAS评分方面差异有统计学意义(P<0.05),而在胸廓活动方面无明显差异(P>0.05)。治疗前后2组的血沉、C反应蛋白相比有明显降低(P<0.05);治疗后2组在血沉、C反应蛋白无明显变化(P>0.05)。治疗前后2组组内的BASFI、BASDAI相比差异有统计学意义(P<0.05),且组间比较治疗组疗效更佳(P<0.05)。结论内热针疗法和常规针刺疗法对中晚期强直性脊柱炎均有较好的临床疗效及安全性,但内热针疗法在改善脊柱关节活动度、缓解疼痛症状、降低致残率、延缓病情等方面的疗效更为显著,安全可行,值得探索和推广应用。     

Fas/FasL在强直性脊柱炎患者外周血T细胞亚群上的表达

目的检测强直性脊柱炎（As）患者外周血T细胞亚群上的Fas／FasL的表达水平，探讨Fas／FasL诱导的细胞凋亡在As免疫学发病机制中的作用。方法以临床确诊的60例As患者作为研究对象，同时选择30例正常对照，运用流式细胞仪（FCM）检测其外周血CD3^＋CD4^＋、CD3^＋CD8^＋T细胞亚群上的Fas／FasL表达水平。结果早、晚期AS患者外周血CD3^＋CD4^＋T细胞上的FasL的表达率分别为（0．59％、0．93％），CD3^＋CD8^＋T细胞上的FasL的表达率分别为（2．93％、4．32％），与健康对照组（0．48％、1．14％）比较，其表达率差异具有统计学意义（P〈0．05）；与健康对照组外周血CD3^＋CD4’、CD3^＋CD8’T细胞上的Fas表达率（58．25％、59．91％）比较，早期AS患者外周血CD3^＋CD4^＋T细胞上的Fas的表达率（64．75％）明显升高（P〈0．05），而CD3^＋CD8^＋T细胞上的Fas的表达率（48．64％）明显降低（P〈0．05），Fas在晚期AS患者外周血CD3^＋CD4^＋、CD3^＋CD8^＋T细胞上的表达率（57．63％、56．32％）无明显变化。结论Fas、FasL在外周血T细胞亚群上的表达水平与AS的病情发展阶段相关；Fas、FasL的异常表达所导致T细胞凋亡功能紊乱可能是AS发病的重要机制之一。     

ASKyphoplan: a program for deformity planning in ankylosing spondylitis

A closing wedge osteotomy of the lumbar spine may be considered to correct posture and spinal balance in progressive thoracolumbar kyphotic deformity caused by ankylosing spondylitis (AS). Adequate deformity planning is essential for reliable prediction of the effect of surgical correction of the spine on the sagittal balance and horizontal gaze of the patient. The effect of a spinal osteotomy on the horizontal gaze is equal to the osteotomy angle. However, the effect of a spinal osteotomy on the sagittal balance depends on both the correction angle and the level of osteotomy simultaneously. The relation between the correction angle, the level of osteotomy and the sagittal balance of the spine can be expressed by a mathematical equation. However, this mathematical equation is not easily used in daily practice. We present the computer program ASKyphoplan that analyses and visualizes the planning procedure for sagittal plane corrective osteotomies of the spine in AS. The relationship between the planned correction angle, level of osteotomy and sagittal balance are coupled into the program. The steps taken during an ASKyphoplan run are outlined, and the clinical application is discussed. The application of the program is illustrated by the analysis of the data from a patient recently treated by a lumbar osteotomy in AS. The software can be used free of charge on the internet at under the heading “research” in the menu.     

幼年型强直性脊柱炎5例诊治分析

幼年型强直性脊柱炎（Juvenile ankylosing spondylitis）不同于成人型强直性脊柱炎的脊柱椎间盘、纤维环韧带骨化融合和骶髂关节破坏,而主要表现为髋膝等外周大关节不对称性破坏所致的反复发作性肿痛,而腰背部及骶髂关节痛不明显。     

强直性脊柱炎髋关节屈曲挛缩全髋关节置换术随访及体会

[目的]观察强直性脊柱炎髋屈曲挛缩畸形实施全髋关节置换术的临床效果,并对常见问题的处理进行探讨。[方法]自1998年7月～2005年9月对18例（36髋）强直性脊柱炎髋屈曲挛缩畸形的患者进行全髋关节置换术,其中同期双侧全髋关节置换10例;平均年龄34岁（17岁～58岁）。[结果]术后随访1～6年（平均3.2年）,对手术前后关节疼痛、活动度、畸形矫正及患者整体功能的改善情况进行了对比。除6侧关节轻度疼痛外,其余关节均无疼痛。关节活动度由术前髋关节屈曲平均20.5&#176;改善为70.5&#176;,髋关节外展由术前平均8.2&#176;改善为45&#176;,Harris评分由术前7～58分（平均31分）改善为56～89分（平均76分）,较术前平均提高45分,有显著性差异（配对t检验P〈0.01）。[结论]双侧全髋关节置换术是治疗严重的强直性脊柱炎髋屈曲挛缩畸形的一种有效的方法,特别是术中仔细松解前方挛缩组织,外侧入路可较好地实施手术,同期双侧手术可使患者尽早恢复功能,节约费用,减少二次手术的痛苦。     

髋关节强直双髋关节同时置换的探讨

[目的]探讨强直性脊柱炎晚期引起的髋关节骨性强直双侧髋关节同时置换术的方法和疗效.[方法]对19例(38髋)强直性脊柱炎合并髋关节强直患者在全麻口插、鼻插下或气管切开插管麻醉下施行双侧同时全生物型全髋关节置换术,手术采用后外侧切口入路,两次截骨后髋臼成形的方法,根据髋关节术前畸形状态调整髋臼及股骨柄角度,安装大一号生物臼、股骨柄假体紧密压配.指导患者早期肌肉及关节功能锻炼.术后均进行了最短1年,最长8年,平均5.5年的随访,对临床疗效及手术相关问题进行探讨.[结果]术后2例出现脱位,经及时手法复位后未再脱位,2髋在扩髓击入假体股骨柄时出现股骨距裂纹骨折,未做特殊处理.6髋发生轻度异位骨化,根据Brooker分期,Ⅰ级3髋,Ⅱ级3髋,病人除感不适外,对功能无明显影响.术后患者均能生活自理.放射学评定骨皮质较术前有明显增粗,骨小梁结构稀疏改善明显.所有患者髋关节主动屈伸活动由术前的0°增加到随访时的平均81°(650～115°),活动度平均达到160.(110°～230°).[结论]强直性脊柱炎髋关节强直双髋关节同时置换可重建患者髋关节,恢复关节功能,提高生存和生活质量.双侧髋关节同时置换有利于双下肢关节功能的协调发展,也可避免两次择期手术间隔时间里因使用不当导致的人工关节损坏,同时能节约患者医药费用又可减轻患者痛苦,利于其他矫形手术开展和负重功能恢复.     

Use of stand-up magnetic resonance imaging for evaluation of a cervicothoracic injury in a patient with ankylosing spondylitis

BACKGROUND CONTEXT: Injuries at the cervicothoracic junction are common in patients with ankylosing spondylitis. These injuries present challenges for both initial and follow-up imagings. PURPOSE: To describe a case of a patient with ankylosing spondylitis who was treated with laminectomy and a cervicothoracic orthosis for a spinal epidural hematoma after a nondisplaced fracture at the cervicothoracic junction and to discuss the merits of stand-up magnetic resonance imaging (MRI) for follow-up evaluation of this type of injury. STUDY DESIGN/SETTING: Case report. METHODS: Clinical data of a patient with ankylosing spondylitis who sustained a nondisplaced C7 fracture are presented, followed by a detailed review of the literature concerning imaging techniques available for the evaluation of cervical spine trauma in this patient population. RESULTS: The patient was treated with emergent laminectomy and evacuation of the epidural hematoma, followed by definitive management in a cervicothoracic orthosis secondary to medical comorbidities. The patient was then successfully followed postoperatively with stand-up MRI because conventional imaging techniques could not adequately image the injury level in an upright position. CONCLUSIONS: Cervicothoracic injuries are common in patients with ankylosing spondylitis and may be difficult to follow with conventional imaging techniques. Stand-up MRI is a relatively new modality that may offer significant advantages over conventional imaging because of the ability to evaluate the cervicothoracic junction in a more functional position and the lack of a confining space such as that found in standard MRI units.     

医疗体操对强直性脊柱炎患者关节功能恢复的效果观察

为探讨医疗体操对强直性脊柱炎患者关节功能恢复的效果 ,随机抽取住院患者 6 0例 ,按入院顺序随机分为两组 ,每组 30例 ,对照组单纯采用药物治疗 ;体操组在常规药物治疗的基础上 ,辅以医疗体操 ,于第 1(治疗前 )、7、15天分别测胸廓呼吸差、脊柱活动度。结果显示体操组关节功能恢复效果显著高于对照组 (P<0 .0 5 )。提示医疗体操能防止关节僵直畸形 ,改善胸廓活动度、降低致残率 ,能促进强直性脊柱炎患者关节功能恢复。     

基质金属蛋白酶和细胞因子在强直性脊柱炎骨破坏中的作用

强直性脊柱炎(ankylosing spondylitis,AS)是以中轴关节慢性炎症为主的原因不明的全身性免疫性疾病。其特点为几乎全部累及骶髂关节,常发生椎间盘纤维环及其附近韧带钙化和骨性强直,也可累及外周关节并造成关节软骨及骨的破坏,晚期可发生脊柱及外周关节强直、畸形以致严重功能受损[1]。所以我们必须强调重视AS骨质破坏发生机制的研究,有利于寻找有效药物,减少致残。1骶髂关节炎组织学研究较系统的骶髂关节炎组织学研究表明,AS的5个阶段不同程度存在滑膜炎、骨髓黏液样变、浅表软骨破坏、肌腱端炎、关节内纤维赘、新骨形成和骨性强直等众多病理表现;其中滑膜炎和软骨下骨髓黏液样变较肌腱端炎更能合理解